Abstract
The present study investigated the functional and anatomical outcomes of idiopathic chronic macular hole (MH) surgery with different surgical approaches related to the chronicity and diameter of the MH. A comparative retrospective study between three groups of patients who underwent vitrectomy for long-duration MH (mean: 13.5 months) was conducted. In the first group of patients (G1 or IP), the internal limiting membrane (ILM) was systematically peeled; in the second group (G2 or IPEP), the ILM and epiretinal membrane (ERM) were peeled; and in the third group (G3 or IF), patients underwent inverted ILM flap technique surgery. Pre- and post-operative best corrected visual acuities (pre- and post-op BCVA) were studied. Macular optical coherence tomography (OCT) scans were performed to measure the MH minimum and maximum diameter pre-operatively, as well as to confirm its post-op closure and evaluate the integrity of the ellipsoid zone (EZ). Fifty eyes of 48 patients (33 female and 15 male) were retrospectively evaluated. MH closure rate was 100% in IP group, 66.7% in IPEP, and 95.2% in IF group. All three groups had a statistically significant improvement of BCVA. EZ post-op was restored in 88.2% of the cases from G1, 41.6% from G2, and 23.8% from G3. No statistically significant relationship between the smaller or larger MH diameter and the visual acuity improvement was found. Patients with chronic MH and ERM have worse functional and anatomical outcomes after surgery. Treatment of chronic MHs without ERM results in a better closure rate with either an inverted ILM flap approach or systematic ILM peel.
Highlights
Macular hole (MH) is a full thickness break in the central part of the neurosensory central fovea that causes poor vision and metamorphopsia [1,2]
Antero-posterior and tangential vitreous traction on the fovea can result in morphological changes that start with a macular cyst and continue to a full thickness macular hole (MH) smaller than 400 μm
Since more complex mechanisms have been implicated in the development of myopic MH, such as strong adhesion of the vitreous cortex and complex vector forces exerted by posterior staphyloma, eyes with axial length (AL) greater than 25 mm were excluded [22]
Summary
Macular hole (MH) is a full thickness break in the central part of the neurosensory central fovea that causes poor vision and metamorphopsia [1,2]. It occurs most commonly in the 6th–7th decade of life and more often affects women than men [3,4]. Antero-posterior and tangential vitreous traction on the fovea can result in morphological changes that start with a macular cyst (stage 1 MH) and continue to a full thickness MH smaller than 400 μm (stage 2 MH). Further development results in stage 3 MH (greater than 400 μm in size and incomplete vitreous separation), and end with stage 4 MH, in which complete separation of the vitreous from the macula and the optic disk as well as frequent epiretinal membrane (ERM) development occurs [1,2,6]
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